Pharmacy Informational Bulletin
Pharmacy Informational Bulletin (PDF , 2 Pages, 50kb)
The Emergency Prescription Assistance Program (EPAP) is a federal program managed by the Department of Health and Human Services, which provides an efficient way for pharmacies to process claims for prescription medications and limited durable medical equipment (DME) provided to individuals who are from a disaster area declared by the President and who do not have any form of health insurance coverage. Claims for individuals with private insurance, such as an individual health insurance policy or employer-sponsored coverage, public insurance, such as Medicare, Medicaid, or other third party coverage, are not eligible for payment under the EPAP.
Eligible individuals may be provided essential pharmaceutical and DME written prescription assistance limited to a one-time 30-day supply for a medication to treat an acute condition, to replace maintenance prescription drugs or medical equipment lost as a direct result of an event or as a secondary result of loss or damage caused while in transit from the emergency site to the designated shelter facility at no cost to the patient. Enrolled pharmacies must check for other forms of health insurance coverage at the point of sale to assist in the determination of eligibility. Claims will be processed for a specific period of time to be determined under an EPAP Activation.
Eligible individuals must have a new prescription from a licensed health care practitioner, a current prescription bottle, a prescription phoned in by a licensed health care practitioner or proof of an existing prescription in order to receive a prescription fill and/or limited durable medical equipment (e.g. canes, walkers, wheelchairs and diabetic supplies). Enrolled pharmacies must dispense the generic form of medication unless otherwise indicated as Brand Medically Necessary (BMN) or Dispense as Written (DAW) by the licensed health care practitioner. To submit a prescription for EPAP coverage, pharmacies must include the following information:
- The Bin number for claim submission is 004410
- The Processor control Number (PCN) for submission is EPAP
- The Plan ID for submission is SANDY012
- The Group ID for submission is SANDY012
- Member ID - Pharmacist to enter the Member ID, please use the following:
- Beneficiary’s First Initial from First Name +
- First Initial from Last Name +
- Year (YYYY) of Date of Birth +
- Month (MM) of Date of Birth +
- Day (DD) of Date of Birth
Example: The Member ID for John Smith born October 4th, 1966 should be entered as JS19661004
- First Name
- Last Name
- Date of Birth
Please note that the areas are subject to change. Updates by FEMA of States and Counties affected by Sandy and eligible for EPAP coverage may be provided thru additional communications from Xerox Corporation and Xerox Business Services, LLC (Xerox).
EPAP Affected Areas
Eligibility for the EPAP – Sandy Activation is limited to individuals who meet the criteria above and are a resident of certain zip codes in the state of New Jersey (Atlantic, Cape May, Essex, Hudson, Union, Ocean, Monmouth, and Middlesex).
If a pharmacy desires to enroll pre-disaster, the pharmacy may call the following EPAP telephone number to enroll 866-561-5933. During a disaster, pharmacies may enroll or if you have questions regarding the EPAP eligibility, covered drugs and durable medical equipment, claim submission, or to inquire whether you are an eligible pharmacy by calling 866-935-4135. This number is only active during a declared disaster in which EPAP has been activated. Enrollment takes only a few minutes. The following link provides information regarding currently enrolled pharmacies. For Current information on Pharmacy Enrollment please review the ScriptCare Website.